A wager on the future: a practicable response to HIV pre-exposure prophylaxis (PrEP) and the stubborn fact of process
In this article we focus on public health’s wager on the social implications of a daily antiretroviral pill to prevent HIV, referred to as PrEP (pre-exposure prophylaxis). The wager is shown to rely on modes of inquiry overly tied to what is known of the present in order to predict the future. Although such inquiry is not unusual when social research is called upon to assist health policy, predictive methodologies are unable to appreciate the dynamic and thus indeterminate nature of process. We ask: what mode of inquiry might practicably appreciate that what happens in the present will have a bearing on the future, without foreclosing on unknown possibles? Drawing on speculative and pragmatic philosophy, we reflect on our own qualitative research on PrEP to suggest that conventional methodological approaches can contribute to the future without seeking to determine what it will become.
KeywordsSpeculative and pragmatic research HIV Pre-exposure prophylaxis (PrEP) Gay men
Many thanks to the VicPrEP study participants and the study’s Principal Investigator, Associate Professor Edwina Wright, who supported us in undertaking the qualitative arm of the study. Thanks also to John de Wit and Martin Holt. VicPrEP was funded by the Victorian Department of Health and Human Services and the Alfred Hospital, Melbourne. Study drug was donated by Gilead Sciences. Thanks also to two anonymous peer reviewers who provided comments on an earlier version of this article.
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